Work ability and anthropometric indices correlate with cardiovascular risk factors in public sector employees: Cross‐sectional study

Abstract Background and Aims Understanding the correlation of work ability (WA) and anthropometric indices with cardiovascular diseases (CVDs) risk factors among public sector employees (PSE) is vital for policy direction. This study examined the correlation between work ability, anthropometric indices, and cardiovascular risk factors among PSEs. Methods The cross‐sectional study had 254 (mean age = 37.18 ± 10.34) PSE. A self‐reported WA index was used to measure WA. Blood pressure (BP), body mass index (BMI), waist circumference (WC), hip circumference (HC), waist to hip ratio (WHR), and visceral fat were measured. Lifestyle CVDs risk history was also obtained. Results 3.9% had moderate, 51.2% good, and 44.9% excellent WA. 37.4% overweight, 20.1% obese, 19.7% hypertension history, 67.7% no physical activity history. WA correlates with increased systolic BP, BMI, WC, WHR, weight to height ratio, and visceral fat significantly. Age 24−29 (aOR = 26.38), 30‐39 (aOR = 7.52), and 40‐49 (aOR = 4.94) independently predict excellent WA. Overweight (aOR = 0.44) independently predict decreased excellent WA. Conclusion Participants were hypertension‐prone, had increased WC, WHR, physically inactive, overweight, and obese. WA and anthropometric indices of the participants predict CVDs risks. Workplace health care strategy should be put in place to control BP, BMI, WC, WHR, weight to height ratio, and visceral fat as CVDs risk factors.

obesity employees are often subject to negative stereotypes, such as being seen as lacking in motivation, laziness, and lower levels of competence compared to employees who have a normal weight. 4duced WA may indicate cardiovascular diseases (CVDs), physical, mental, and social instability. 5,6Physical, mental, and social instability can lead to negative weight, body mass index (BMI), waist circumference (WC), and waist-to-hip ratio, obesity, and related health hazards. 7,8Predicting cardiovascular risk factors in working populations, particularly in the public sector, has grown in popularity. 9udies have shown that public sector employees (PSE) work under pressure, are overworked, and spend much time working tediously, neglecting their health. 10,11In Ghana, most PSE are expose to stress workload, role ambiguity, role insufficiency, work family relations, adverse working conditions, career development, time pressure, individual factors, organizational adjustment, changing global scene, and working under two perceived supervisors. 12,13The nature of the work of PSE is such that they may not even have spare time to eat well, engage in physical activities, or even go for regular medical checkups. 14,15PSE who may be prone to CVDs are detected and diagnosed late, hence there is low survival rate most times. 16Optimal performance at work will only be possible when cardiovascular risk factors such as hypertension, overweight, obesity, physical inactivity, diabetes, alcohol consumption, smoking status, and poor eating habits [17][18][19] are at their lowest level in relation to workload. 202][23] Other studies have also found total body fat, or BMI, rather than its distribution, is the stronger predictor of metabolic risks. 24,25[28] Ghana, a developing nation with limited resources, continues to experience an increase in the CVDs mortality rate, which accounts for approximately 50% of fatalities. 29,30Workplace CVD prevention would require understanding how job abilities and anthropometric indices predict cardiovascular risk factors.CVD are among the leading causes of death worldwide with negative effects on human productivity. 31,32rther information on the interaction of WA and anthropometric indices with CVDs risk factors among PSE is vital for policy direction.
This study examined the relationship between WA, anthropometric indices, and cardiovascular risk factors among PSE.This study presents evidence on WA and anthropometric indices as predictors of CVDs risk factors in PSE, which will influence future research and workplace interventions to promote employee health and well-being.

| METHODS
A cross-sectional study design was employed in this study conducted among employees at public institutions within the Kumasi Metropolitan Assembly (KMA).KMA is one of the 260 metropolitan, municipal, and district assemblies in Ghana.KMA is one of the 43 districts in Ashanti Region in Ghana, with Kumasi as its administrative capital.
The study was conducted in line with the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) for observational studies. 33e study participants were recruited through a random sampling technique.The random sampling technique ensured that each participant has equal opportunity to be selected as established the literature. 34The sample size was obtained by the formula 35 : n = (Z 2 x PQ)/e 2 , where: Z is the standard normal variate at a confidence interval of 95% = 1.96.p is the prevalence = 7% of CVD in Ghana, e is the margin of error = 0.05, and Q = 1−p.n (minimum number of participants) = 1.96 2 x 0.07 x (1−0.07)/0.05 2 = 100.Hence, a minimum of 100 participants was required for the study. 35

| Inclusion and exclusion criteria
Full time employees of public institutions within the KMA were included in the study.The study used PSE who experience high level of bureaucratic practise, tend to avoid unpaid overtime work, whose remunerations are often disbursed early and rarely delayed, more likely to be absent from work, tend to experience less stringent oversight responsibilities, and have job security when compared to private sector employees who were excluded.Employees of private and part time employees of public sectors are habitually dedicated to their job, rarely go to work late and often endure any challenge encountered for the sake of not losing one's job.

| Instrumentation
Demographic data on age, educational level, marital status, number of children, residence, religion, work experience (years), and working section was obtained.Lifestyle related information (e.g., smoking status, physical activity, and alcohol consumption) was also obtained.
Omron body composition analyzer and nonelastic tape measure were used to measure anthropometric indices.An Omron sphygmomanometer was used to measure blood pressure (BP) and heart rate of the study participants.
The WA Index (WAI), a self-assessment instrument, was administered to measure the work ability of the participants. 36The WAI describes how well an employee can do his/her job. 37It is recommended as a diagnostic instrument for the development of measures for health support and the identification of employees who require medical care. 38,391][42] The WAI measures seven aspects of WA: current WA compared with the lifetime best; WA in relation to the demands of the job; number of current diseases diagnosed by physician; estimated work impairment due to diseases; sick leave during the past year (12 months); own prognosis of work ability 2 years from now; and mental capacities. 36The maximum score on the index is 49 points, and the minimum is 7. Except for items 2, 3, and 7, for which there are specific scoring criteria, the total score is calculated by aggregating the points of each item.For Item 2 (labor aptitude relative to job requirements).The labor aptitude score for the job's physical requirements is multiplied by 1.5 (answers between 3 and 5).Multiply by 0.5 the work aptitude score for the mental demands of the task.Answers between 1 and 2. The WA score for the physical demands of the job is multiplied by 0.5 (answers from 1 to 2). 36The WA score for the mental demands of the job is multiplied T A B L E 1 WAI Cumulative Index (Range 7−49 points). 25

Points
Work

| Anthropometric measurements
The height and weight were measured to the nearest 0.5 cm and 0.1 kg, respectively, while wearing light apparel and without shoes.The BMI formula was (weight [kg])/height 2 (m).Data obtained were categorized according to standard. 47,48The average of the waist and pelvic circumferences was used for further analysis.Hip circumference (HC) was measured at the level of the greater trochanters.The waist to hip ratio (WHR) was then computed.This section presents the findings from the study.

| DISCUSSION
This study examined the correlation between WA, anthropometric indices, and cardiovascular risk factors among PSE.Findings showed that 57.5% were at least overweight, 38.6% had a history of hypertension, and 67.7% had never taken part in any physical activity, which reflects sedentary living (Table 3).This finding reflects the increase in the current burdens of obesity and hypertension in the working class or labor force. 50,51The lifestyle issues also reflect

| Conclusion
The majority of participants had at least moderate WA, which is associated with a prolonged active work life.Nonetheless, there was evidence of correlation between hypertension, physical inactivity, overweight and obesity, increasing WC, and increasing waist-to-hip ratio among participants whose work schedules left them with little or no time for healthy living, as well as the association between WA and anthropometric indices and CVDs risk factor components.
To reduce the burden of CVDs in Ghana, early detection and control of risk factors, prevention and education programs, treatment, control of noncommunicable diseases, and lifestyle modifications must be intensified to enhance the health profile and quality of life.
As CVD risk factor components, BP, heart rate, BMI, and visceral fat were measured and recorded.After each participant had sat for at least 10 min, two consecutive BP readings were taken from the participant's right arm.The systolic and diastolic BPs were recorded to the closest mmHg.If the difference between the two readings is greater than 4 mmHg, a third reading is taken.The subsequent analysis used the average of the two BP measurements.As the onset and disappearance of Korotkoff sounds, systolic and diastolic BP (SBP and DBP, respectively) were determined.Visceral adiposity was determined and recorded.The questionnaire on knowledge of cardiovascular risk factors (Q-FARCS)49 was modified to elicit information on CVD risk lifestyles.The information elicited includes history of diabetes (No or Yes), history of smoking (Never, Former, and Current), alcohol (Never, Former, and Current), hypertension (No or Yes), physical activities participation (Never, Sometimes, Always), time of physical activity (Less than 1 h, 1−2 h, More than 2 h), type of physical activity aerobics, if any (Gym/walking/football), too much intake of salt (No or Yes), take fruits and vegetables (Never, Sometimes, Always), and experience of heart attack or pain (No or Yes) were obtained.Before data collection, the participants were given a thorough explanation of the study protocol and assurances of anonymity.Also, ethical approval was obtained from the Committee on Human Research, Publication, and Ethics, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (Ref: CHRPE/AP/024/22).Authors declare that the work has been done in accordance with the declaration of Helsinki statement of ethical principles for medical research involving human subjects, including research on identifiable human material and data.2.4.1 | Statistical analysis Microsoft Excel 2019 was used to enter, cleanse, and code the collected data.All statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS) Version 26.0 and GraphPad Prism Version 8.0 (GraphPad Software, www.graphpad.com).Means and standard deviations served as the representations of parametric variables while medians and interquartile ranges served as those of nonparametric continuous variables.Variables of a categorical nature were represented as frequencies and percentages.Utilizing a Pearson χ 2 test statistic and logistic regression analysis, correlation of cardiovascular risk factors as independent variables and WA as dependent were determined.A confidence interval of 95% and a p-value deemed statistically significant at the 0.01 and 0.05 levels (2-tailed).

F I G U R E 1
Proportion of work ability among study participants.T A B L E 4 Association of demographic information with work ability.
Demographic characteristics of study participants.History of cardiovascular risk factors of the participants.

Table 2
while the case reversed with excellent WA (47.7% < 51.8%).Workers in the procurement department had higher WA than others (18.5%).Workers without children had better WA (36.2%).Participants who had worked for between 1 and 5 years had better WA (46.1%).Based on BMI category, the WA index of underweight participants was better (40.9%).
Association of work ability and components of cardiovascular risk factor.Work ability and history of cardiovascular risk factors.
206][57][58]alues indicate factorial analysis outcomes.From Table6, there was significant association between history of diabetes (p < 0.000), history of hypertension (p < 0.000) and work ability index.ratio,andworkcapacityas seen in literature.[56][57][58]Thisstudyfound that demographic and lifestyle characteristics of age, marital status, BMI, and number of children correlated with job performance as recently submitted by Kaewdok et al.20that a person's physical attributes like age, weight, and musculoskeletal capabilities and lifestyle variables like leisure-time physical activity, diet, smoking, and sleep and his job capacity index.
Workplace health care strategy should be put in place to control BP, BMI, WC, WHR, weight to height ratio, and visceral fat as CVDs risk factors.
4.2 | RecommendationCardiovascular disease can be prevented by limiting behavioral risk factors such as cigarette use, poor diet, obesity, physical inactivity, and problematic alcohol consumption.To reduce CVDs risk factors and enhance the health profile and quality of life, it is necessary to intensify lifestyle modification education.